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HomeMy WebLinkAboutBUSINESS PLAN;~ ` ;~~. f o ~, ' ~ ~ ~ _. :~ `I 2500 WHITE LANE VAL~IE GASOLINE INC. I~ ~~ ,~ I l,~ :5,; o0 :,UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING I SB989 SECONDARY CONTAINMENT TESTING (TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMR N0. 14R/ ARf'~I f BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Pie 1 of 1 ^ ENHANCED LEAK DETECTION ^ ^ SB-989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST ~ TO PERFORM FUEL MONITORING CERTIFICATIO_R\ FACILITY NAME 8 PHONE NUMBER OF CONTACT PERSON ADDRESS OWNERS NAME OPERATORS NAME NUMBER OF TANKS TO BE TESTED PERMIT TO OPERATE NO. IS PIPIN IN TO BE TESTED9 ^ Y S ^ NO TA K # L M CONTENT (~ C-- ~ /~r-~m -~ TANK;TESTING COMPANY NAME OFT TING COMPANY t NAME 8 PHONE NUMBER OF CONTACT PERSON MAILING ADDRESS (~roo - ~ ~ NAME 8 PHONE NUMBER OF TESTER OR SPECIAL INSPECTOR } CE TIFICATION #: DATE 8 TI E TEST TO BE CONDUCTED . C~~h ICC #:. ~ ~ ~ TEST METHOD SIGNATURE OF APPLI NT c DATE ~ ~ ~Q i APPROVED BY DATE FD 2095 (Rev. 09/05) BILLING & PERMIT STATEMENT BAKERSFIELD FIRE DEPT. Prevention Services PIIB~ 900 Truxtun Avenue, Suite 210 ~ PERMIT NO.: wR111 r Bakersfield, CA 93301 . LOCAT40N OF PROJECT - PROPERTY i STARTING DATE COMPLETION v 4 NAME J PROJECT NAME ADDRESS - a PHONE NO. ~n / PROJECT ADDRESS oO 1 _ ~ 1 IL _ CfTY STATE ZIP CODE~~~ ~)( CONTRACTOR NAME CA LICENSE NO. TYPE OF LICENSE. EXPIRATION DATE PHONE NO. // -~~ / CONTRACTOR COMPANY NAME FAX NO. ~ ' O lf~ ADDRESS CfTY ZIP CODE ~~ u • • ~ ^ Alarms -New & Modifications - (Minimum Charge) $262 50 • ~ • . 98 Over 20 000 Sq FL FL x 013125 =Permit fee Sq ~ ^ , . . . 98 ^ Sprinklers -New & Modifications - (Minimum Charge) $210 00 ~ . 98 ^ Over 5 000 Sq Ft 042 =Permit fee Sq Ft x ~ . , . . 98 ^ Minor Sprinkler Modifications (< 10 heads) $ 93.00 [Inspection Only) ~ 98 ^ Commercial Hoods -New & Modifications $ 398 26 ~ . 98 ^ Additional Hoods $ 36 00 ~ . 98 ^ Spray Booths -New & Mod cations $458 00 ~ . 98 ^ Aboveground Storage Tanks (Installation/Insp.-1~ Time) $165.00 82 ^ Additional Tanks $ 26.00 82 ^ Aboveground Storage Tanks (Removal/Inspection) $109.00 82 ^ Underground Storage Tanks (Insta/labonJlnspection) $878.00 (pertank) 82 ^ Underground Storage Tanks (Modification) $878.00 (persite) 82 ^ Underground Storage Tanks (Minor Modification) $155.00 82 ^ Underground Storage Tanks (Removal] $675.00 (pertank) 84 ^ Oilwell (Installation) $ 72.00 ~ 84 Mandated Leak Detection (Testin /Fuel Monit. Cert. $ 81.00 (persite) ~ 82 ^ Tents $ 93.00 (per tent) 84 ^ After hours inspection fee $122.00 ~ 84 ^ Pyrotechnic - (Per event, Plus Insp. Fee ~ $90 per hour) $ 60.00 + (5 hrs. min. stand --by fee /Inspection) _ $510.00 84 ^ RE-INSPECTION(S) /FOLLOW-UP INSPECTION(S) $ 93.00 (per hour) 84 ^ Portable LPG (Propane): NO.OF CAGES? $66.00 84 ^ Explosive Storage $249.00 84 ^ Copying & File Research (File Research Fee $33.00 per hr) 25¢ per page ; 84 O Miscellaneous ; 84 FD 2021 (Rev. 09/05) 1 -ORIGINAL WHITE (to Treasury) 1-YELLOW (to Flle) 1-PINK (to Customer) __ __ _ _ ,, i 1 - - _ (~ 1 IV101V•rTOR~NG SYSTEM CERTI~'YCATYON For Use By A11 Jurisdictions YYirhin the State of Catifornia . te;rlta•irt• Cirzil: Chapter 6.7, Heath and Safety Cade; Chapter 16, Dlvisivn 3, TIt1e 2.i, California Code vfRegulativns Chi; sLnn must 5e used to document testing and servicing of monitoring equipment, 8,~e}~ara~e certifigation or rgpott must be pr~ai-~d !:ur..:=aTt~ monitoring sLtem con~oi panzl Uy the redmician who performs the wort:. A copy of this form must be provided to tht tank ;~;a~ns s~~~•ner/opzrator. The own~,•loperaror must submit a copy of this form to the local agency regulating UST systams within ;U ~1:~~; u[ rr;r da[e. ,=~. t~rtier3l Ynformation F_tcllit} Nati»: JL~ (,~2'S $ldg. No.: ._.__ -.... ~it~ _lddress: ~~S7~U ~c%~?_L ~- ~-3.1 ._ Ciry: +EY'~~~~~/~G.t~ Zip _!~3J'~L.__,.. . t'ar an Cosuact Person: ~_~>~(t-J _ Contact Phone No.: ~____~~ _,_, ___ ,~ (aka. hloti~i of Monitoring System: ~_,.~,,,,5 ~ .~i$`d Date of Testing/Servicing: ~/ f / r'_d~. ,L. i~rr'e.tttory of Equipment Tested/Certified ~.I;c,+. ,L c :,uproUriutt buses to indicate specific rquipmrn[ inSprcIedhervieed: I,-:..~_._.- ~.i Tank ID• (1.,~/l`~/ ti ~ t;~-1.rnl. Ci•auging Ptobt, ivlodel: _)~_ __ ~ (>i[ In-Tank Gauging Probe. _ Model: ~~ ..._~.. _.... 4 ~;' 1D ;uuurlar Space or Vu,h Sensor. Ivlodtl: 4 ~ O Mnular Space or Vault Sensor. ModeL• i'I ~- yd 1=ipiuY, Sump i 'trench Sensor(s). Nfodel: '~.rl Jd Piping Sump /Trench Sensor(s). 114ode1: __,_._,,, .._ ;~ y' U }ill tiunlp Sensor(s). Model: ^ Fill Sump Sensor(s). Iti'lodeL• _ ''d ~ 1\ tc~h.ulicxl Line leak Detecwr. Modal: ____s~'fl'3~_._ ~U Mechanical Line Leak Detecror. Model: ~J~{,~Ct_,__.. ~' 1J l'.IGC[rJniC Lll3z Leltl: Detaclor. Model: ^ Elecuonic Line Leak Detector. Model: ~~ :J C::nl; Ovtrtill /High-Leval Sensor. Model: ^ Tank Overfill /High-Level Sensor. ___. `_• . • .. . Model: _,_.__ ~ hl O Ulh~.r h zciI • e ui meat t • e and model in Section L' on Pa e 2 . ~~ O Other (s eci'~ a ui meat t e and model in Secrion E on Ya c ? i. ....- 1 font; lD: _ Tank TD: ._„ _- j+~ in- i'snl: Gauging Probe. Model: ~1 O In-Tani: GaugingProbe. - Model; _.._, ._- ,~ ` .:1 :~,un,lar Spare or Vt,ulr Sensor. Model: D Arrnuiar Space or Vault Sensor. Model: _ _ `~ ,~ N i!iln,> >unrp i french Sensor(s). Model: ~ ~ O Piping Sump i Trench Sensor(s). Model; ~~~• ___._ ' i; ~) 1~ ill 3urnp Sensor(s). Model: D Fil] Sump Sensor(s). ModeL• ___ _ _ _ _ p, ,~1c~h:wical Line Leal: Detector, Model: ~/~j~_ ~ O Mechanical Line Leak Detector. Model: _ __ _ ~ di J 2~.!«uvui~ Line Leal; Detecror, Model: O Electronic Line Leal: Detector. Model: __ _ ~ ~ ;~ 1::1 t':u,l; 0 Terrill /High-Level Sensor. 1Ulodel: O Tank Overfill /High-Level Sensor. Model: _.__-_ ¢ kl J_ ctulcr is ~~ih~ r, ui meat a curd model in Secrion F, on Po e 2 . O Other s eci a ui meat ~ e and model in Section E on Pa z ^_). 1 1)ispc,isrr 11J: __ 1 "~- _ ~ DispenserlD: .~ ~ `~ _... ,„ 1h-p~u~cr Conrainmenr Sensor(s). Model: ~' Di enser Containment Senso s Model: 'f' ~. til!~i; \-alT~z(s). .. J~ Shoat Valve(s). ;~~ k ~J t?,; parser Containment 3;loar(s) and Chain(s), ^Dis enser Containment Float(s) and Chains . s _ ` ~~ . _ I. l U,~pc„srr 11}: _ ~ -(~ Dispenser iD: ,n ____.. '1 ,J ~ t~tsp~n~er Containment Sensor(s). Model: 3-d B' ¢J Dispenser Containment Sensor(s), ModeL• _ __.,_ . •_ it .~ Sh.:.+r 1'alve(s). FO Shear Valve(sj. _ ~~ i;i tits xnsrr Containment )lost s and Chains . ,~._~..e. - - O Dis enser Containment Floats and Chain s). ~'~ --i~ ~- II Oisl,cuser ll): Dispenser ID: - ;. ~J t?+sp~nser Containment Sansur(s). Model: ^ Dispenser Containment Sensor(s), Model: __.. __.._ . _ ., u ~i ~i Si,c::u \~ nh~r.(s). O Shear Valve(s). 19, `1 D;; :sls~r Cuncsinment Flours and Chain s). O Dis enszr Containment Floats and Chain s . ~ .; li rL: ru~ilil)• contains more tangs or dispensers, copy this form- Include information for every tank and dispenser at the facility. ~~. ~, f't'Y1f1C~tiori - I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacuu•ers' >uirieliurs. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verity that this information is ~ormct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, l ha.•r also :,rrachrd a copy of the report; (check a!/rhar apply): ~ System set-up ~ ~ rm history r po i'e~iutician Namz (print): ~~~}~ Q't~ S banature: I -_.--.-_.._. ~:erliiirarionNo.: O~{,~`~X,,i - ~7 ~ License.No.: 61/D40- #809BS0 ,_~..___... 2cstin~;Conspa,iyName; RICH ENVIRONMENTAL PhoneNo.:~661 ~ 392-8687,..,,•__.. ~it~ .-~.itir~ss: ~~_~i~/tjL~~ L.y ~j~'~ff~ ~.i} Date of TestingfServicin~; ~/ / I_r _dr~ Page 1 of 3 03ii+! !l1,~,;ir+~rilrg System Certtl'ication Iy. i~csuits uf'll'estittg/Servicing J(~73 ~oin~ar. Version lnstalled: `~. ~~ ~L.04u;ICt~ the t'ullowinv checklist: ^~~~ O Nu* Is the audible alarm o erational? ~I 1 ~~ i ~ ^ No* IS the visual alarm o erational? ~--'' _....~ ~~ l"~, ^ No* ,_•~ Were all sensors visuall its eeted, ftmctionaIl tested, and confirmed o erational? , ~; --- ~ ~ ~~ l7 Nof _ I Were all sensors installed at lowest point of secondary containment and positioned so that other equipment wilt ~! not interfere with their -•o er o erasion? ~~ 1.: ^ Nu* Y If alarms are relayed to a remote monitoring station, is ail conununications equipment (e.g. mo~leru j ~I I NiA operational? ~ ~ l~ 1 ~s ^ No ~ For rzssurized i to s stems, does the turbine automaticall shut down if the t to second containment ; p P P~ o Y Y p•p• $ ary `_ ~ 4 i la N;A monitoring system detects a leak, fails to operate, or is electrically disconnected? if yes: which sensors iniri:ur i ~; positive shut-down? (Check ctll that apply) ~' Sump/Trench Sensors; ~ Dispenser Conraiivment Sensors. '! ' Did you confirm ositive shut-down due to leaks sensor failure/disconnection? ,~! Yes; O No. _~ _ ij ;_i ~ ~ ^ No* For rant. systems [hat utilize tl-z monitoring system as the prinary tank overfill warning device (i.~.. no ~ ~ ~ N%A mzchanical overfill prevention valve i5 installed), is the overfill warning alarm visible and audible at thy. tanl; !; '~ till uint(s} and o eratina ru erl ? If so, at what ercenr of tank ca act does the alarm tri~~zr? ° ,, i~ j ~~ ~ ~_'~ ~. No Was any monitoriig equipment replaced? If yes, identify specific sensors, probes, or other equipment repia~.z~i and ! ist the manufacturer name and model for all re ]acement arts in Section E, below. I _ _ ~J 1 ~s^` l~ Nu Was liquid found inside any secondary containment systems designed as dry systems? (Check all Char up~dt 1 CJ i! Prodttct• D Water, If es describe causes in Section E below. ~! ~, l c~ ^ Nu* Was monitorinJ s stem set-u reviewed to ensure ro r settings? Attach set u re orts, if a licable ,i `_~ 1 ~~ ^ No* is alt monitorintr e ui Wien[ o erational er manufacturer's s ecifications? - • _ '~ ~tu S~criun 1= belo-v, describe bow and when these deficiencies were or wilE be correcfed. l~, ~,~;trtmenrs: Page 2 of 3 i).;;nr ~:'- r~-'t'.~~ik Gauging / Sl[R Equipment: ,la-l- `____ ~ Check this box if tank gauging is used only for inventory cunrev I. O Check this Uox if no tank gauging or SIR equipment is instrzlleci. -.t':.-,:> ,:coon must be completed if in-tank gauging equipment is used to perform leak detection monitoring. ('n~nr.i.~ra the l;~tluwine checktist~ ~~CI ^`~ as D Nox Has ail input wiring been inspected for proper entry and termination, incl.udi-~g testing for ground faults^ ii (=i ,1 c; ^ No* ~ ~1 Were 311 tank gauging probes visually inspected for damage and residue buildup? -_ u ~~~> j l:] No* _ Was accuracy of system product level readings tested? ;~ - .....-r.-~-i LU ~ ~_, I ~ ^ No* '-----' - Was accuracy of system water level readings tested? U 1 ~~s ~ ^ No* Were all probes reinstalled properly? I Ls ` . ^ No* Werz all items on the equipment manufacturer's maintenance checklist completed'? i. to ttt4 Section H, below, describe how and when these deficiencies were or will be corrected. ~. ~t.ii,e Leal:.lletecturs (LLD): ^ Check this box if LLDs are not installed. i'~,,ar,1Nr,~ rtiN 1'i,llnwinv rhecklict~ ~~ ~ `:" O No* For equipment start-up or atutua] equipment certification, was a leaf: simulated to verify LLD perfonnanc~.'.' ;~ ^ N!A ~ (Check all that apply) Simulated leaf: rate: R~13 b.p.h.; D 0.1 g.p.h ; O 0.2 g.p.h. ~~ i l'~ '~ ~; O No* Were al! LLDs confirnled operational and accurate within regulatory requirements? ~! {' ~~ 1 ~; ^ No* Was the testing apparatus properly calibrated? ~~ ~ ' ~! ~ ~lT 1, s ^ No* For n3echanieal LLDs, does the LLD restrict product flow if it detects a lean? '~_ ^ N!A ' ~~ ^ 1 ~; O No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ~ ~f ~ l~ NIA 'll U Yz; ^ No* For electronic LLDs, does thz turbine automatically shut off if arty portion of the monitoring system is disabl~~1 ~ _ ~ N?A ar discottrtected? j' ~ u 1 ~; ^ No* _._. ; Fur electronic LLDs, does the turbine autotnaticaily shut off if any portion of the monitoring system ma(timcriurs, !; ~ ~ NIA or fails a rest? u 'r ~s O No* -----,~ For electronic LLDs, have all accessible wiring connections been visually inspected? ~ N!A ~ t' ~s ^ No* Were all items on the equipment manufacturer's maintenance checlaist completed? li L * ~n riir Section H. below, describe how and when these deficiencies were nr wilt be rnrrecteri. J[-f. Cutttmettts; )Page 3 of 3 ua,n ~ Ia~Y ~'1.Ot11Till'lll~T S1'sieln Certification 1JS'~' 1V1[onitoring Site Plan , .. .. ~ ~PR-t..:~ . ter. .~ ~ t L ...... . t ~ . ~ . , . a o .... .. . ~ ~ ..... .: . o . ...... . S . . . s: ::::::::::::r a::::::::::::::~~ 4::::::::: P ~ I i I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ```,A~~~` j ~ .w`~. . _ .\ i ; - ~~ 1 a .... .. .. :::::: ~ : ~ ~/17~-1 J ~ ::: ~: ~:::::::::::::::::::::: Date map was drawn: ~/ ~~ /~. Instructions f t ~ pli. e]re~jdy have a diagram that shows all required information, you may include it, rather than this page; ~wiih ~ ~n~r 1~l~ulitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly idcncil-~ l~~r:~rion~ of thin following equipment, if installed: monitoring system control panels; sensors monitoring tanl: annul,~r' ;p:-~es, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line Ical. der~crors; rind in-rank liquid Ievel probes (if used for leak detection). In tl~e space provided, note the date this Site Dian ~.~.;• Prepared. Page / of ~ t~:~,un ~: ~ a~ ,KI ~,13N'jT_IR0~1TML~NTAL ` 5643 SAOOK3 CT BAKR&.~FI$LD,CA.93308 j OFFICB(661}392-86$7 & FA8 (661)392-0621 M~82~S~ T+_.i~'~~.T2i3T~i~A.~us a~T WD Tt S,~E:I~T i W/0#s 1 t Facility Name: ,y~'t-t1 '" ~~. Facility Address: ,~2(Z (~1jt~~ C,~ 6/~1LtlP~Sj /,L`C.JJ, ~/'~ ~f ~ r•. PraduCt Line Type {Pressure, suction, Gravity) 1 ~~~.,5 U PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS SERIAL bitTL~S$R BELOW PSI OR L/D TYBR G~ v S 8 s$RIAL ~ D ~' No ~ FAIL z, k7 L/D TYPE 38RIAL # ~ 1 NO ~~ FAIL ~ y ~ ~ /~ L/D TYPB g Q I ~S~ L 9SRTar• # NO l ~ FAIL L/D TYpSL Y8S PASS STRIAI, # NO FAIL I certify the above tests were conducted on this date according to i Red Jacket Pumps field test apparatus testing procedure an limitations. i The Mechanical Leak Detector TQVt pass / fail is determined by using a low flow threshold trip rate og 3 gallon per hour or less at 1Q P3I. i I acknowledge that all data collected ie true and correct to the beet of my knowledge. Tech: ~ 'J 1" 1~c Signature• Date: - ~~` s~ 7 c•• .~I t a,~ ::vFTWtaRE REb'I:,IOfV LEVEL VEk~IGPI 17.01 SOFTWAREit 34E017-100-B GREA'PEC~ - 9H . 1 ? .04.1 1 .35 1V0 SOFTWARE •hiODULE SYSTEh1 FEATURES: PERIODIC IPJ-TANK TESTS ANfVUHL IN-TANK TESTS S'YSTEf°1 SETUP fVOV 11. 20u5 11 :119 AM SYSTEh1 UNITS U.S. S'YSTEht LANGUAGE ENGLISH 5'YSTE!°I DATE,~TIME FORMAT MON DTi 'i'!`!'! HH : MNI : SS xM VALU-GAS 2500 WHITE LA1'JE BAKESFIELD CA 93304 SHIFT 'PINE 1 12:30 AM SHIFT TIME 2 DISABLED SHIFT TJME 9 DISABLED SHIFT 1'I ME 4 DISABLED TANk: PERIODIC WARNINGS DISABLED TANK ANNUAL WARNINrB DISABLED LINE PERIODIC WARNINGS DISABLED LINE ANNUAL WARNINGS D I SFiBLED PRIfVT TC VOLUNIES EtVABLED TEhIP COMPENSATION VALUE (DEG F ): L;0.0 STICK HEIGHT' OFFSET fi I SAPLED H•-PRO'fO%OL DATA FORMAT HEIGHT DAYLIGHT :.AV I fVG T I h1E ENABLED START DATE APR WEEK 1 SUN START TIME 2:OD AM END DATE GCT WEEl: 6 SUN E1VD TII°IE 2:00 ANI RE-DIRECT LGGAL F'kINTOUT DISABLED IN_TANK SETUP- - - - - _' COMMUNICATIONS SETUP T i:UNLEADED 1 _ _ _ _ _ _ _ _ _ _ _ _ PRODUCT CODE THERMAL COEFF :.000700 TANK DIAMETER 131.75 PORT SETTINGS: TANK PROFILE 1 PT 12026 • FULL VOL CONU°I BOARD 1 (RS-2327 BAUD RATE 9ti00 PARITY EVEN FLOAT SIZE: 4.0 IN. 649' STOP BIT 1 STOP ~ 2 DATA LENGTH: 7 DATA • WATER WARNING 0 3 . HIGH WATER LIMIT: AUTO TRHNSMIT SETTINGS; MAX OR LABEL VOL: 120 6 9 °° OVERFILL LIMIT AUTO LEAK ALARM LIMIT 108.3 9~°~ DISABLED HIGH PRODUCT 1144 AUTO HIGH WATER LIMIT 1 DISABLED DELIVERY LIMIT 1813 AUTO OVERFILL LIMIT DISABLED CT 10 AUTO LOW PRODUCT 9 LOW PRODU TRANSMITiREPEAT LEAK ALARM LIMIT: : X50 AUTO THEFT LIMIT SUDDEN LOSS LIMIT 1 22 DISABLED •; TANK TILT HUTO DELIVERY START ' TRANSMITiREPEAT MANIFOLDED TANKS i AUTO DELIVERY END Tg: NONE TRANSMITiREPEAT , AUTO EXTERNAL INPUT ON U~ DISABLED LEAK Mlld PERIODIC: 1 02 AUTO EXTERNAL INPUT OFF DISABLED ° AUTO SENSOR FUEL ALARM % I10 LEAK MIN ANNUAL : Ii202 TRANSMITiREPEAT AUTO SENSOR WATER ALARM B SENSOR OUT ALARM AUTO PERIODIC TEST TYPE STANAARD DISABLED AUTO REPEAT TIME: 60 MIN ANNUAL TEST FAIL AUTO DELAY TIME 5 SEC ALARM DISA~LED PERIODIC TAL RM DISAI~LED A RS-232 SECURITY GROSS TEST FAIL i LARM DISF~LED CODE 000000 A ` OFF ANN TEST AVERAGING: PER TEST AVERAGING:; OFF ' TANK TEST NOTIFY: i OFF RS-232 END OF MESSAGE DISABLED • TNK TST SIPHON BREAI~:OFF DELIVERY DELAY : 1~ hI1N SYSTEM SEC'UR I T`! CODE 000000 - ~ l 0~`1~ T '~ : PREh1 I Uhl T 3: D I ESEL PRODUCT CODE 2 PRODUCT CODE 3 LEAK TEST METHOD THERMAL COEFF '• OOU7U0 THERINAL COEFF :.000450 - - - - - - - - - - - THNk; DIAMETER 13)• 75 TANK DIAMETER 131.75 TEST MONTHLY : ALL T1~IVK TANK PROFILE . I PT TANK PROFILE 1 PT WEEK 2 WED ' FULL VOL : 5057 FULL VOL 503b START TIME 2:00 AM TEST RATE :0.20 GALiHR DURATION 2 HOURS FLOAT SIZE: 4,u IN , 8456 FLOAT SIZE: 4.U CN. 8496 WATER 6JARNING g 0 WATER WARNING 2.0 HIr;H WhTEF. LII°IIT: • 3 p HIGH WATER LIMCT: 3.0 LEAK TEST REPORT FORM/iT • ENHANCED I"1H%>'; Gk LABEL 1/0L: 8057 MAX OR LABEL VOL: 5036 OVERFILL LII°lIT y0% OVERFILL LIMIT 90% • HIuN PRODUCT- 7251 95% HIGH PRODUCT 4532 95% ~ • DELIVERY LIMIT ^654 20% DELIVERY LIMIT 4784 20% • 1611 1007 r LCiW F'RGDUCT LEAK. ALARIW LII°1 I T: 109 y LOW PRODUCT LEAK ALARM L I M I T: 1000 99 ~ SUDDEN LOSS LINIIT: 50 SUDDEN LOSS LIMIT: 50 TAIVK TILT 1,07 TANK TILT 0.00 LIQUID SENSOR SETUI~ _ _ _ _ _ _ _ _ _ _ _ _ I°itiN C FGLDELi Tr31VKS MAN I FOLDED TANKS Tts: NONE T#: NONE L 1 :ANNULAR TRI-STATE (SINGLE FLOATi ' CATEGORY ANNULAR'SPACE LEAK I°I I IV PER I OD I~^.: l 0,; LEAK M I N FER I OD 1 C: 10% • [305 503 LEAK I`1 C N r-iNNUAL : LEAK M! N ANNUAL 1 D% L 2:87 STP • 805 503 TRI-STATE (SINGLE FLOAT) CATEGORY STP SUi~ FERCODIG TEST TYPE PERIODIC TEST TYPE ' UTANDARD ~ STANDARD I, 3:92 STP TR1-STATE (SINGLE~FLOAT) ANNUAL TI~T PHIL AIdNUAL TEST FAIL CATEGORY STP SUMP ALARM DISABLED ALARM DISABLED PERIODIC TEST FAIL PERIODIC TEST FAIL L 4:D[ESEL STP i ALARM DISA BLED ALARM DISABLED TRI-STATE fSINGLE~FLOAT) ' CATEGORY STP SUMP GROSS PEST FAIL GROSS TEST FAIL ALARM DISABLED ALARM DISABLED ' L 5:DISA 3-4 ANIV TEST r~VERAGIIVG: OFF ANN TEST AVERAGING: OFF TRI-STATE (SINGLEjFLOAT) PER TEST AVERAGIPJC: OFF ~ PER TEST AVERAGING: OFF CATEGORY DISFEN~ER FAN TAIVk: TEST [NOTIFY: OFF TANK TEST NOTIFY: OFF ~ TIVK TST SIPHON BREAK: OFF TNK TST SIPHON BREAK :OFF L 6:DISP 5-6 TRI-STATE (SINGL>~ FLOATi DEL i t1ERY DELAY : 15 hl I N DELIVERY DELAY 15 M I N CATEGORY D I SPEt+~SER PAIN L 7:DISP 7-8 TR!-STATE (SINGLE FLOATi CATEGORY DISPENSER FAr L B:DISP 1-2 TRI-STATE fSIWGL,E FLOAT CATEGORY AISPENSER PAI - - I cap" **~~xEND**~i~* ALHkM HISTORY REPORT RELA`.' SETUP GUTFU'T Y - - - _____ SYSTEM ALARM ----- PAPER GUT R 1:t~7 NOV 4. 2005 8:18 AM TYPE: PRINTER ERROR STAIVDHRD JVGV 4. 2005 8:17 AM NGRh1HLLY i;L'uSED BATTERY [5 OFF JAN 1. 1996 B:DD AM ALARM HISTORY REPGRT L I QU I D :%ENSUR HLNtS - I tV-TANK ALARM ---'- '"- HLL:FUEL ALARM ALL:SENSGR OUT ALARM T 2:pREN1IUM HLL:SHGRT ALARM ~; R 92 OVERFILL ALARM 000 1.1:31 23 t TIFE: MAR • 7:34 AM MAR 12. 20UD AM STFtNDHRD MAR 4, 2000 10:D7 NGRMHLLY CLOSED x ~ x ~~ * END ~ ~ x x LOW PRODUCT ALARM 2005 1:42 PM LIi~UID SENSi1R ALMS M NGV 4. PCT 24. 2005 2:26 ALL:FUEL ALAR PCT 2. 2005 HLL:SENSOR GUT ALARM HLL:SHORT ALARM INVALID FUEL L$ 47 PM R 9:UIESEL AUG 24. 2004 AEC 22. 2001 15 1 TYPE: : 6 PM OCT 25. 2001 STHNDHRD NORNIF;LLY CLOSED PROBE OUT 11:43 AM ~ ALHRhI HISTORY REPGRT MAR 15. 2005 20D5 11:25 AM LIGUID.SENSGR HLMS ---- IN-TANK ALARM ----- MAR 15. DEC 19. 2000 8:29 AM ALL:FUEL ALARhi ALL:SENSOR OUT HLARM T 1:UNLEADED ALL:SHORT HLARM DELIVERY NEEDED R 4:REhIGTE ALARM OVERFILL ALARM NOV 7. 2005 11:40 AM 2005 4:44 PM 1 T','F'E: JAN 15. 2005 5:40 PM , NOV 2005 3:40 PM T 21 STANI'~ARD JUL 31. 2003 7:46 AM . OC NURMHLLY CLOSED JUN 18. 2003 1:22 PM LOW PRODUCT ALARM LIQUID SEPVSGR HLMS SEP 7. 2005 3:31 PM HLL:FUEL HLAR1~1 JUL 11. 2005 8:15 PM ALL : SEtVSOR GUT ALARMM JUN 25. 2005 8:54 AP9 HLL:SHURT HLARhI HIGH PRODUCT ALARM OCT 21. 2000 12:54 Ahl INVALID FUEL LEVEL e * END JUL !2. 2005 10:26 AM ~ * * ~ SEF 21. 2004 11:58 AM JUL 16. 2004 1:41 PM PROBE OUT MAR !5. 2D05 10:55 AM ' DEC 18. 2000 11:28 AM ~ ' DELIVERY NEEDED SEA 7. 20D5 6:47 AM AUG 18. 2005 7:18 PM AUG 14. 2005 8:50 PM LOW TEMP WARNING DEC 18, 2000 12:59 PM .- - - ARNOLD/JAMES GROUP LLC Manager TERRI ARNOLD Location: 2500 WHITE LN City BAKERSFIELD CommCode: BFD STA 07 EPA Numb: BusPhone: Map 123 Grid: 13C SIC Code: DunnBrad: SiteID: 015-021-001954 (661) 634-9293 CommHaz Moderate FacUnits: 1 AOV: Emergency Contact / Title Emergency Contact / Title ALBERT GONZALES / ASST MANAGER TERRI ARNOLD / PRESIDENT Business Phone: (661) 634-9293x Business Phone: (661) 634-9293x 24-Hour Phone (661) 205-3890x 24-Hour Phone (661) 871-9242x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards :. ____.____ Fire ImmHlth DelHlth Contact TERRI ARNOLD Phone: (661) 634-9293x MailAddr: 5301 OFFICE PARK DR 420 State: CA City BAKERSFIELD Zip 93309 Owner VALU GAS INC Phone: (661) 634-9293x Address 2508 WHITE LN State: CA City BAKERSFIELD Zip 93304 _ _ Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif' d: RSs : No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG U - UST - - - - __ ~NT`~ ~ ~G ~ 3 X007-- -- - -- Based on my inquiry of the those individuals infermatio , responsible for obtasning f law that e rsonally 1 have p under penalty o r d am fa+ril with ma true or {h , is tion examined an submitted and believe accurate, and comp! ~ - - _ ~`®".~~ 1~ _ .Date ~ - - _ Signature -1- 06/29/2007 It ~~t3 ALtiRP~I H I STc~RY REPORT --- - 1 N-TAN}' ALHRIN - T 3 : Li I ESEL ALARM HISTORY REPORT SENSOR ALARM L 1:ANNULAR AiVNULAR SPACE FUEL ALARM NOV 11. 2005 10:23 AM FUEL ALARM OCT 29. 200x3 1:37 PM SEhtSOR OUT ALARM OCT 31. 2003 9:56 Ahl ALARM HISTORY REPORT OVERFILL NLARM SEP 16. 3003 2:01 PM JUL 34. '200:3 6:38 PM LUW PRODUCT ALARI~9 Ur.T 24.. 2005 3:32 PM JC"T 15. 2005 11:31 AM OCT y. 20D5 7:36 AM 11V1JHL I D FUEL LEVEL UrT 4. 2005 7:51 HM AUG 9. 2005 10:26 AP'1 DEC l4. 2004 7:55 HM PRuBE OUT DEC 22. 2003 11:26 AM DEG 2~'. 2003 11:25 AM NOV 14. 2000 9:01 AM DELIVER' NEEDED OGT 24. 2005 3:04 PM ocT 15. 2005 11:30 AM OCT 9. 2005 5:01 HM LU3J TE1°1P WARNING IdUV 14. 2000 9:03 Ail C?C•T 16. 1999 3:01 AM x x ~i iE ii END n x**~*END~~~~~i ----- SENSOR ALARM ----- L 3:92 STP 8TP SUMP FUEL ALARM NOV 11. 2005 10:22 AM FUEL ALARM OCT 29. 2004 .1:35 Ph! i FUEL ALARM OCT 31. 2003 5:29 HM ~ x * ~ * END ~ ~ * ~ x NLARM HISTORY REPORT -- SENSOR ALARM ----- i ~ L 2:87 STP STP SUMP ALARM HISTORY REPORT FUEL ALARM NOV 11. 2005 10:22 AM -- SEfVSOR ALARM -'----~ L 4:DIESEL STP ~ FUEL ALARM STP SUMP OCT 29. 2004 1:34 PM FUEL RLARM NOV 11. 2005 10:22 HM FUEL ALARM ~ OCT 31. 2003 9:29 AM FUEL NLARM OCT 29. 2004 1:36 PM FUEL ALARM OCT 31. 2003 9:31 AM x x END * x ~ ~ ~ _. _. ~x~~xENDx~~c;'r H1.AIal°i H I STOR~~ REpURT -- SENSOT~ ALARM __ L 5:DISp 3_4 --- D I SFEIVSER PH N FUEL ALARM tJOV } ! . 20tJ5 10:32 AM FUEL ALARr~} uCT 29, X004 I:42 Fh} FUl~L HLARM bEC 17. 003 9;33 ~ .e x.RxxEND~;f~~~e ALARM HISTORY ~EF'URT L-6:bJSP ~~~ ALARM ----- DISFENSER PAN FUEL ALARhI fVt}V 1 t . 2005 10:32 AM FUEL ALARM FE8 3. 2u05 10:45 Ahf FUEL ALARM OCT 29. 200q 1:45 pM * " '~ " x ENU i~ '~*~~ ALARM HISTORY REPORT -- 8EN54R ALARM ----- L-7:DISP 7-e AISPENSER PAN FUEL ALARM IVOV 11, 2005 10:33 AM FUEL ALARM OCT 29, 2004 1:54 PM FUEL ALARM OCT 29. 2004 1:43 PM ~ x ~ ~ x END * x ALARM HISTORY REPORT -- SENSOR ALARM -- L B:DISA 1-2 DISPENSER PAN FUEL ALARM NOV 11. 2UQ5 10:31 AM FUEL ALARM OCT 29, 2004 1:40 PM '. ' FUEL HLARM OCT 29, 2004 1:40 FM *~*~~ENU~x~c~~ i "~'~=` ~: 1 l ~~3 MONITOR CERT. FAILURE REPORT SITE NAME : V ~L, ~ ` CJ~/U , DATE : '~~ " J I ' U{~ ADDRESS : ~~[7 tJ /~I T'~ ~. •'l> TECHNICIAN : ~Y/~'cJ ~ clTx: THE k`OLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE TAE MONITOR CERTIFICATION TESTING. LSST OF PARTS REPLACED/REPAIRED:. REPAIRS: LABOR: ~~ v~~ PARTS INSTALLED: ~GTJ~ -~ .~ T , .^ . -_%,-' UNDERGROUND STORAGE TANKS APPLICAT{4N 70 PERFORM FUEL MONITORING CERTiFICATfON ~~a~3 BAKERSFIELD FIRS DI~PT. wiaw Preveut3an 3iertrlcos ~l~1 ! 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel: (66'1) 326.3979 Fax: (661) 852-2171 P~a,al ~FACtLiTY DDRESS a soo W ~a_vtie -- n ~ S{~` ~?j~l~ `j O:%~Kgl'Urt~ NwME ~ i ~WNERS NAMF ~I TANKB VOLUME CONTENTS L I r / i L___ i I-- -- _ v ...., ~ ; ~~ • . ,~~ ~-, WAME OF TESTIN COMP NY ,'I ~ ii i. AILING ADDRESS ' - l ~ X38 ~ ~wnSE ~ PMONE N1t149 F CONTACT P SON _ t ATE d T1ME TEST 8E CO I tt- TED l~oa m CC i , IGNATURE OF ICANT ~ tt~~.~ C ~_:__. ATE ~ ~ ~ 5 ~ T~3 APi+L,iCATfAN 9ECQOAB~ iA P6R14rT WiiE~l AAPi~YQD ~----- i jAPPROVED BY i ATE ~ f ~ ~: Fp21 Qa (Mv. aYOll) i ~i I' I ' t I J t ~' 't' a +~ i' :. i.` .r•; ::~ .S, } , ~~_~.~ ~,~ . ;,,~~ ~, w ~., .~ SLCC~ib'~`SYSTENr CERT~CATION FO~VI :~; , `..: FACILITY ADDRF '~S..ba ~~L~/• ~~,~T/~~Q GQ- ., :, . ;'s`' '' UST Aaan~r Spaax •'~ ~.~ .. 9 ~ .. .... .. . ,. i:. '~'~ ..tp~ , 1'adk 1 Tattlc ~ Task 3 .T~rk 4 . R ~ gl ~~, ~,~ a. ~ ~ ~~c rime $ ' :. i~; l!+ 114 Fi~4 ~ ./~~-V ~ "~~ T;, i. ~" ,. ~.` ~ ~~ ,,...; l4 !? `~ !• ~~.' ~ 'A~l, ins: ~,av~-fA,vk 5/'Cl~fiai~/< . ~~~;. ~M; Seeaa'derY Plplag '; 1 c~5 :. 1' 7 ~r: ~.. . it ~fi - ~..~II ~' 1 ~ , ' ~ ,~i ;'.,>~ ' - SE£ONl7-'~ ~1~5'I'EM CERTIFICATION FARM ', ~. - ,,,..y DATE ~ 11 ;~~~:: FACILI'T'Y ADDRE~B ~~~'...,..-r- ~c~'y• •a ~` . .i! ,y ~, /h~. - .~.r:•' - r'. Ttll'~R11E SULtIQi ~.;ai :,,:.,, . c- .~ ; .,.... `s~ . S ,• -r ' ,; . , ;. ,~ :* , :; t. . ~t, %~~. ,1 , +..,. . ~; ~ . ,, . :~,~: . ~;:~ ~' ' ~,. ;,. . 1; ~ . F::; " . a.' 5v~p Zg. _ , Sump Z ~ Sump ~ ~ Sump 4 Mart Time ~- ~ ' ,' TTelght ~f Water .~ . 1 ~" _ ~/y7.:..~ . 01 ,'..• - 'I'ia,e ,'~O ~ 9 ~ 9io i~v~ty x~gtic 9 : ~ ~ •0 f ~ ~~ 9 water ~Ieight /3!~/r~; ~/y .,, ~, .~, .. 9~ 9:~D Water t / ~ .~ . yy7;~ ? . ~,~ ~eretnt~an ~s~~~ ~~f - ~. ; ~ ~~ T'~S .' / / +dvrrAl! Bucker A fi:.._ ,. (h-erdli 2 Overipl3 ' pverlTti 4 $t~rt Time ;.-gyp ~ ,' tnitinl H,elght bf Water . ,..:. . . `~ ~ j r', ,, ~ ~ 3 7 i - l • `~qj/>-.. !waarr I~ctgtit ,.~137r..s~°- ~ .U3?~.-~ r. 9 90:.~ rCartllkatloa ~51ge~atun) ~` ~ ~ .IGGG! O .. / Page 2 of 3 / !c~-z5' A' ~ .~p , ;~ ,~ ~., ~~z:, '. ~.i17,` <'. 7, > t~. , u~ '' SECI`~NI2~4AY SYSTEM CERTIFICATIOI~1 FQRiVI . ~5' „~ DATE 1~ 1~ t 6 S , ~~: FACILTFY " U~' ' c~ C "'~ ~~" : FACILITY ADDRESS ~ I ~_:~ . ' ~;~, ~' UDC TESTING ' . ~~:' ,,. . c~ ., ,•ti,; ,.~... ~',~ . ~:,, ,., , . :,. . .r , ~~:; r. ,:. ~; . ;. D~l9PE1~19~1 :DISPIENSER 2 DISPENSER 3 DISPENSER 4 START TIIVIE /p ~ ~ ~ ~ p . ~ - IrItTiAL HEIGHT OF wATER . . ~a4/-~ ~; ~ ,~ 1: ~ ~• 701.E TIME 0-;i,~ d /~ ~~w~ WATER HEIGHT .°~~~ N ~~-( ~,,~ J~ •~/ OIL TIME ,CQ.' Gl :e~D O s3 WATER AEIGAT -~l °!i ~~~ - y~°J1,-~ ~~alF,~ / :x/101.-~ cEArl~c~-Tior~ (SIGNATURE ~~ s ~ . ~ ~~ D~:3PEN8^;~ .. DISPENSER b , DISPENSER 7 DISPENSER 8 . START TIME INITIAL HEIGHT OF WATER . TIME . WATER ~ ~ , HSIGIIT . ' TIlVIE ~VNATER , HEIGHT C~RTIFlCA'i'tON G~CGNA131RB) Page 3 of ,j t{'3~5 h ., UNDERGROUND STORAGE TANKS a:k.~w.~ ._., _ .. ~...~.4:.:~,:~,,,_........ APPLICATION TO PERFORM ELD /LINE TESTING / SB989 SECONDARY CONTAINMEN l" TESTING •~ JTANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERT~ICATION PERMIT NO. l t ~ I -- OZ3 v ^ ENHANCED LEAK DETECTION ^ TANK TIGHTNESS TQS"T ~' 'i t ~ -----.. ,FACILITY ~ /~ ~~ DDRESS aSUD WNERS NAME PERATORS NAME^~~'j^~~ UMBER OF TANKS TO~BE TESTED TA(~K a._ r _._T__ _T_ _._.____ __ ~-._.~._ ____ _ __ PERMIT 70 OPERATE NO. _ _,__ ~ _......_.__-- -_-.~_. __~,_ ~_T _ GOING TO BE TESTES? _~_,-YES .._.-. _. Q- NO__ _____ ._. VO.LU.ME ....---__,-,_CONTENTS__.___.. _.-._______~_~_~__~._._..___a.--. -_.__.,.._.._.__...~,.._ ._...... _._~,._.._ ..__.._.__.._~.__ ~._~. I p• I ---.~-... .. I .- .. _ .-. -.- _..._.- ... .. ~. i i. I I y 1 I I TANK TESTING COMPANY NAIyiE---.F~NLR..OM__~~~. - _ N_A(,11?f,~,~ N,r~...._i N7 ~_ (.v IERSd__-_- ~o R_ ~.~ ..._., MAILI G ADDRESS I ~ CA ~~3a NA~~ PHO~J~ N 6ER QF TESTER OR $ Ca~NSPECTOR ~CER~1~tFlCA"flOi~ u __...__~~l ~~~-~=~$7. OSo3Sia-9~ oS~3Sr3~- _ DATA t E TEST TO ~E CONDUCTED ICC a: TEST ETHOD ~ ~ 1 ~ ao o ~ _ _ _----_---___- --._ __ ------_.._________ ----_.._ - --- ___y~ ~--_. __ SIGNATURE OF: AP fICAN7 BATE O- D~ __. --____._.___.--_ _ ~'3~__-_ __.. __ .. __.___._ ___.___-___. ~~ - ~ ~` ~ ~ TKI~ APP~~CATION @ECOtti(~ES A PER~GtIT N APP_EtOV~D ~1PPROVEP BY! ~ U~; i c. ~ C FD2iG6 ` ~ .:: I' ( ~i I J ~ ~ °x I .. ~, • ': ^ LINE TESTING SAKERSFIELD FIRE I3EP'I'. Prevention Services ~1t)t)'1'rTl~tun Ave.. Ste. 210 i3~11;~~rsji~~lcl, C`~~ 93:301 I'cl,: (~i61) :326-3~i7Si F~~ax: (661) X52-217 I Page ~ of i SB•tii&5 SECONDARY CONTAINMENT TESTING ^ TO PERFORM FUEL MONITORING CERT;fICATION _ _. _ _.._ __..._ S4TE INFORMATION _ __ _ _ _ ~JAME & PHONE NUMBER OF CONTACT PERSON /~ ~1 a nt~,slr A 1!' ilA1 1 ~~ Baker§fielcl Fire a~egr: ~ 131LLING 8~ P>=RMIT ~~J~TEMENT Px~vErrTi©rr sERVicES , ~ Fire Safety. Services • Environmental Services ~ 17I5 Chester Ave Bakersfield, CA 93301: ~ ~' ' ~ '"~ TeL (661)326-3979 ~} ts~ `~ ~ :DATE...,., ..n" - - - f UST/AST,/PERMIT, TANK TESTING .~ ~t ..~ ~ ~ 82 I STATE SURCHARGE 86 r ~ ... TENTS, LPG, FIREWORKS; POWDERIOTHER PERMITS 84 COPIES/REPORTS 89 FOLLOW-UP INSPECTION r°' ~ ~~ ,7 Y , h s ~ ~_..,,^' ark x +.~ :.{, ~ BUSlNESSNAME -- ~ _ - ~ -- -- - - ---- c ~L TELEPHONENUMBER(5) -.,~ . r f ~ .h ~ ~~-1 ~ fe. )` 4..j i ~ ~ ~ ti..-+'~ BILL TO - - i \ PAY BY -~ -ii ~ ~" y , NOTES ~'~ ~~' ~`~ 7 •,` i ..- --- -- -- ---T- - -- -- ----- 'CUSTOMER8IGNATURE. ~ INSPECTOR/RECEIVERSIGNATURE'. ~„_ ,, - _ _ j,. ~ b i .,/~ .y -- C1RIr IN AI WNrt F~ FIN AN!•F rll<rnr;~co oiriv n~~i~c- vci ~ n,n, ~FD17.34~(fP.V ~7~n~~.. I ~JI~D~RGROUND STORAGE TANKS APPLICATION TO PERFORM FUEL MONITORING CERTIFICATION -r-r - a ~ g BAKERSFIELD FIRE DEPT. west Prevention Services AalII t 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel: (66'1) 326-3979 Fax: (661) 852-2171 Page 1 of 1 -. _ -- SI ,I MATIpN -- - a •,. ~<; '3€ I AGILITY i DDRESS ~ S O~ lJ~ I~~, ~.C~--w ~-x- g(l~i~--~ S~ ~ ~ C ~ ~~i~~~~ 1 OPERATORS NAME WNERS NAME -- ~ ~~( -- - _ - - TANK# VOLUME CONTENTS j i t ~ V _ ~ I ~ TES'PI}S~COMPATIY AME OF TESTIN COMPANY 1. I AILING ADDRESS - S r - e q3~ ' NAME & PHONE NUMBS OF CONTACT P RSON _, ~ _ ATE & TIME TEST BE CON TED ~i=~ ~ /~~oo m CC # iGNATUP.E-OF- LICANT ... -- _ ATE /~ ' Ti~1RS APP AT~N 9EC04AES A PEFIDAIT' WHEN APPROVI`D PPROVED BY ~ % ATE J FD210;6 (Rw.owosl ~~ ~ :- - ... ~:~~ .,Gp TTY OF BAKERSFIEI.U FIRE DEPAR'T'MENT EFI OF >h:NVIRONMENTAL SERVICES NIFIED PROGRAM INSPECTION CHECKLIST X15 Chester Ave., 3r`' Floor, Bakersfield, CA 93301 FACILITY NAME ~)~<<}>' Cn6, h INSPECTION DATE ~ ~ r~~'LI _ Section 2: Underground Storage Tanks Program ^ Routine Combined ^ Joint Agency ^ IVtulti-Agency 3 ^ Complaint ^ Re-ins ~ction Type of Tank ~UJt-C.S Number of Tanks '~~ Type of Monitoring .~~4tn _ Type of Piping ~ilF ~~ OPERATION C V COMMENTS Proper tank data on the Proper owner;operator data on the - . Permit fees current • r', Certification of Financial Responsibility Monitoring record adequate and current i Maintenance records adequate and current Failure to correct prior UST violations ~ _. Has there been an unauthorized release? YeS NO Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPACITY Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on the with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overf711/overspill protection'? C=Compliance V=Violation Y-Yes N-NO Inspector: e Office of Environmental Services (661) 326-3979 white - 1?nv. Svcs. .* Business Site Responsible Party Pink -Business Copy _-.. !+ UNIFIED PROGRAM INSPECTION CHECKLIST SECTION~n1 n1 ~u~siness j~P~ lean and I~1n'ventory Program Q'/1, M ihY~ L a,/l nMOd , tiVI,~K~ /.~~ V Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 rH~u.ii r rviamc y .. ..._. - ..... ...... __...... ....._ ADDRESS ~ (, ,,,,~ PHONE No. No. of Employees FACILITYCONTACT ~ Business ID Number 15-021- ~s Section 1: Business Plan and Inventory Pn~gram ^ Routine ~jCombined ^ Joint Agency ^Mnlti-Agency ^ Complaint ^ Re-inspecti -C/V \ V=Vb ationnce l OPERATION COMMENTS Lr ^ APPROPRIATE JPERMIT ON HAND t~ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^~^ VISIBLE ADDRESS ,~ ^ CORRECT OCCUPANCY ~ L~ ^ VERIFICATION OF INVENTORY MATERIALS L~' ^ VERIFICATION OF QUANTITIES ~~// _ [3 ^ VERIFICATION OF LOCATION __ _ _ _ ENT~_ ~ ~ ~} ~ 1-~~~j L'J ^ PROPER SEGREGATION OF MATERIAL -T- 1- --f-- --------------------------------___------._-----------...--- --,_.__.._ __-----------------------._...- --- .....__ U ^ VERIFICATION OF MSDS AVAILABILITYE C~ ^ VERIFICATION OF HAT MAT TRAINING (~^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES - ---- -- - ---- ---- --- ^ EMERGENCY PROCEDURES ADEQUATE - -J ---- - -- ---- --- . -- --_ ..-- - - .. U ^ CONTAINERS PROPERLY LABELED ~ --- ----- --- _ __ -t- --- - ------ ---- -- ___- - -- ___ - _ __ _.. --___ __ L'1 ^ HOUSEKEEPING U ^ FIRE PROTECTION Q'~^ SITE DIAGRAM ADEQUATE Sc ON HAND i ~ ~ ANY HAZARDOUS WASTE ON SITE?: ^ YES ^ NO EXPLAIN: QUESTION REGARDING THIS INSPECTIONS PLEASE CALL US AT (66~) 3ZG-3979 Inspector Badge No., Business Site Responsible Party White • Environmental Services Yellow - Statbn Copy Pink • Business Copy .~ OVTiNG EQVES~ Please... To: ` - ^ Read L~(Handie , ~j Approve And... ^ Forward From: ~~ , ^ Return ^ Keep or Toss ~ieview with Me Date: Post-d" 7664 C~3M 1993